FOAM EMCC Blogs 2018

Since 2009 we have reviewed and revised the Emergency Medicine and Critical Care (EMCC) blog/podcast database. It has been a great way to add new resources; marvel at the global collaboration and wealth of educational resources in the #FOAMed blogosphere and analyse the trends in the use of social media, and blogging platforms.

In this 2018 analysis we review the #FOAMed blogs, platforms and social media integration of Free Open Access Medical Education and compare growth with the 2012, 2014 and 2016 reviews.

Please let us know if we have missed you off the list, or details need updated


Review of prospectively collected data pertaining to Emergency Medicine and Critical Care (EMCC) blogs and podcasts providing Free Open Access Medical Education (FOAM) with no barrier to entry (e.g. readers not required to logon to site or pay to read/listen).

A total of 460 EMCC blogs, vlogs and podcasts were identified and reviewed in December 2018. Data was collected relating to platform; content; publication (onset, duration and current activity); country of origin; primary language; social media channel integration; RSS feed; and legal disclaimer. Comparison was then made with the previous census reviews of 2012, 2014 and 2016


Current activity (viability)

The 460 EMCC blogs/vlogs/podcasts were reviewed and identified as either:

  • GOOD (216) Currently active with at least 1 post within last 6 months)
  • GOING (111) Previously active. At least 10 published posts, but zero posts/podcasts for the 6 months between June-December 2018
  • GONE (133) Inactive. Previously active (with at least 10 published posts) but zero posts/podcasts for greater than 12 months; or inaccessible; or permanently redirected; or incorporated into another EMCC website

Country of origin

EMCC blogs are now written in 16 different languages (up from 6 in 2014) and originate from 40 different countries (up from 24 in 2014).

Global reach increased from 224 (2014) to 227 countries in 2018. Below is an example of reach and country engagement with an English language based FOAM blog (LITFL) using the Google analytics data for 2018.

Scroll over the interactive map to reveal Geo-located visitors per calendar year.

+Figure: EMCC Blogs/podcasts Languages 2018
EMCC Blogs podcasts Languages 2018 2
+Figure: EMCC Blogs/podcasts Country of origin 2018
EMCC Blogs podcasts Country 2018

Blogging Platform

WordPress remains the blogging platform of choice being used by 70% of EMCC bloggers (up from 44% in 2016). The majority of these blogs are self-hosted with wordpress.org (63% of wordpress blogs). It will be interesting to see how the arrival of Gutenberg in WordPress 5.0 will affect these platforms and users.

The number of Blogger users continues to decline. From a peak of 24% in 2014 the platform now accounts for 11% of active websites. Squarespace, Drupal, Joomla and Wix account for 6% of users

+Figure: EMCC Blogs/podcasts Platform 2018
EMCC Blogs podcasts Platforms 2018

Social Media Engagement

Successful active blogs and podcasts had previously shown an increasing propensity to use social media to engage in online discussion and information dissemination.

Twitter continues to be the mainstay of social media interaction and information dissemination for blogs/podcasts. However the proportion of active EMCC sites with active Twitter accounts has fallen from 86% in 2016 to 80% in 2018

  • Facebook pages maintain a steady growth in popularity from 32% (2012) to 41% in 2018
  • Google+ use also increased from a low of 16% (2016) to 20% in 2018 with some active community G+ pages leading the way.
  • Media accounts such as YouTube/Vimeo held steady, up slightly from 12% (2012) to 15% in 2018.
+Figure: EMCC Active Social Media accounts 2018
Social Media and Blogs

Social Media Conversation #FOAMed

The FOAMed hashtag has become a useful means of disseminating media and medical education posts and advances in the twitter platform have made it easier to search, review, share and comment on posts/podcasts.

#FOAMed on Twitter is still the major source of referral and conversation in the online space. It’s use has grown significantly and the number of active users (with #FOAMed in their twitter profile) has increased from 500 in 2014 to 1,800 in 2018

We previously used Symplur to analyse the use of the hashtag; the participants; and the global reach – however, this is sadly no longer a #FOAMed resource for large data collection.

In the interim here is a sample survey from EMTA (Emergency Medicine Trainee Association UK)

+Figure: EMTA Survey 2017
Emergency Medicine Trainee Association UK

Growth rate and Attrition Rate

New blogs are in decline; niche blogs are being incorporated; and some old stalwarts have said goodbye…

A saturation point has been reached. The rate of attrition has overtaken the rate of growth for the first time since 2002.

Growth and attrition of EMCC blogs 2018

133 blogs/podcasts have been identified as ‘deceased‘ since the commencement of data collection in 2009. There have been 30 recorded deaths since last review:

  • 20 deaths were sudden with the blogs moving straight from Good (active) to Gone
  • 10 have been palliated since 2016 review from Going to Gone

Of the 133 blogs that no longer exist:

  • 68 point to alternate sites (mainly porn…)
  • 48 still exist but the last published post >24 months
  • 9 force a 301 redirect with larger site incorporation
  • 8 have been marked as ‘private’

Age Milestones

  • The average ‘age‘ of the blog at the time of euthanasia is DOWN from 52 months (4.3 years) to 34 months (2.8 years)
  • The average ‘age‘ of the currently active blogs/podcasts is UP from 62 (5.2 years) to 71 months (5.91 years)
  • The longest running blog (gruntdoc) is currently at 2013 months (16.92 years)

Interesting factoids:

  • Disclaimer: A legal disclaimer now exists on 91% of sites
  • Anonymity: There is better identification of authors with 97% of blogs and podcasts citing the full name, credentials, contact form and geographical location of blog authors. Particularly important since the arrival of the Google EAT protocol


Has the FOAM bubble burst? The rate of blog attrition has overtaken the rate of blog growth for the first time with 30 deaths and only 19 births since the 2016 review. Previous surveys have detailed the growth of active websites: 67 (2011); 130 (2012); 201 (2013); 275 (2016) and now 216 in 2018

In part this is because we have reached a natural saturation point. In part the bigger blogs have become established and incorporated enthusiastic authors from smaller blogs. There is only so much information, so much time in the day both to prepare the material and digest it…sometimes life just gets in the way.

Then there is the cost of FREE, and it is huge. This cost, both in dollars and in hours, is undeniably associated with some of the attrition.

  • Financial: The larger the reach; the greater the visitors; the more considerable the bandwidth – the more substantial the cost. LITFL has 1.5M visitors/month and 2TB bandwidth; in dollars that is $50,000USD/yr
  • Time: Blog maintenance, platform design/integration, writing, editing – all takes time. Some solo blogs have been incorporated into larger blogs or College/Hospital websites where the administrative and technical load can be spread.

However there is an increased global spread and reach with blogs being accessed regularly in over 220 countries. EMCC blogs continue to lead the way in the online open access medical education provision. There are myriad stories to be told; processes to be evaluated and discussed; and dogma to be lysed…

This saturation point was inevitable, with so many educational resources being shared freely and without reservation through FOAM. I don’t think it is the end of the movement, but will certainly heralds a major shift in the landscape. Free information will still be produced and still disseminated with free social media platforms…but we may see a smaller number of significant stakeholders.


Some Discussion:

EMCC Blogs/Podcast 2019
Finn'EMTwitterFB, IG
PAINE podcastTwitterFBPodcast
Military MedicineTwitterFBMedia
EM PulseTwitterFBPodcast
33 ChartsTwitterFBG+
EM GuidewireTwitterFBPodcastMedia
MedED GuruTwitter
The BreachTwitterPodcast
EM Clerkship
Admin EMTwitterFB
Break EMTwitterFB
EM SandboxTwitterFBPodcast
IM ReasoningTwitterFB
EM Over EasyTwitter
Dutch ResusTwitterG+
Torrey EKGTwitter
EM DailyTwitter
Monkey EM
Island Docs
Docs D'UrgenceTwitterFB
DownEast EMTwitterFBMedia
Emergencia RulesTwitterFBPodcastMedia
Oxford Med EdTwitterFBMedia
Paediatric FOAMTwitterFB
Ultrasound GelTwitterFB
RATHEM BlogTwitter
StonyBrook EMTwitter
Total EMTwitter
5 Min SonoTwitter
The CMEMedia
EM Curiosa
My Emergency Dr
RPH Doctor
EM Cage
NUEM BlogTwitter
Bold City EM
ffolliet presentations
The 9th Call
IM Reasoning
Geeky Medics
The Silk City Blog
Reddit Emergency Medicine
News Papers
Aciltip TVTwitterFB
Core EMTwitterFBG+Podcast
EM3 SimulationTwitterFBG+Media
EM3 Mini TeachTwitterFBG+Media
EM KenyaTwitterFBG+Media
EMRA BlogTwitterFBMedia
Kings of CountyTwitterFBMedia
Aneszt ITOFB
MUE VodcastsTwitterFBMedia
Time Critical Medical EducationTwitterFBG+Media
Seymour EMSTwitterFBG+
The CurbsidersTwitterFB
Brown EMTwitter
EM SIM CasesTwitter
EM DidacticTwitterG+
PEM PlayBookTwitterG+Podcast
First 10 EMTwitter
GEM PodcastTwitterMedia
RCEM FOAMedTwitterPodcast
GP Paeds TipsTwitter
GP Paeds TipsG+
RACP Podcast
EM Rounds
ED ECMOTwitterFBG+PodcastMedia
EMIG castTwitterFB
60 second EMTwitterFBG+
EDE BlogTwitterFB
Temple EMTwitterFB
Adventure MedicTwitterFB
The Bottom LineTwitterFBG+
CEM FOAMed NetworkTwitterPodcast
EM FundamentalsTwitter
Humaizing Intensive CareTwitterG+Media
Intensive BlogTwitter
Mayo EM BlogTwitter
Pondering EMTwitter
Saudi EMTwitter
Everyday EBMTwitterG+
EMJ ClubTwitterFBPodcast
Crit CloudTwitterFB
Critical Care PractitionerTwitterFB
Don't Forget the BubblesTwitterFBG+
EM DocsTwitterFB
Rebel EMTwitterFBG+
The PEMNetworkTwitterFBPodcast
Taming the SRUTwitterFBPodcastMedia
EM in 5TwitterMedia
Reviews and OpinionsTwitter
Laceration RepairTwitter
EM NerdTwitterG+
Maryland CC ProjectTwitter
Thinking Critical CareTwitter
WikEM BlogTwitter
Global EMSTwitterG+
ER GoldBook
Adult Emergency Medicine
Charlies ED
EMJ BlogTwitterFB
Ottowa Emergency MedTwitterFBMedia
EM on the EdgeTwitterFBG+
Emergency Physicians InternationalTwitterFB
PEM BlogTwitterFBPodcast
The Skeptics guide to EMTwitterFBG+PodcastMedia
Auckland HEMSTwitter
Edinburgh Emergency MedicineTwitter
Emergency Medicine PharmDTwitter
ECG of the weekTwitterG+Media
KI DocsTwitterG+
The Short CoatTwitterG+
PedEM MorselsTwitter
Emergence PhenomenaTwitter
Google FOAMTwitter
M2E Too
Airway Jedi
Emergency Medicine CasesTwitterFBG+Podcast
EMJ PodcastTwitterFBPodcast
EM PillsTwitterFBG+Media
capriles urgenciasTwitterFBG+
Intensive Care NetworkTwitterFBG+Podcast
Tox NowTwitterFBPodcast
Ultrasound PodcastTwitterFBG+PodcastMedia
Sinai EM USTwitterFBMedia
Sinai EMTwitterFB
St Emlyns BlogTwitterFBG+Podcast
UMEM PearlsTwitterFBMedia
EM EducationTwitter
Broome DocsTwitterG+PodcastMedia
Critical Care ReviewsTwitter
Crashing PatientTwitter
EM Lit of noteTwitterG+
REMI Journal of Intensive Care MedicineTwitter
Flipped EM ClassroomMedia
Emergency Medicine updatesTwitterFBG+
Global Emergency CareTwitterFBMedia
Free Emergency Medicine TalksTwitterFBPodcast
Emergency Medicine IrelandTwitterG+PodcastMedia
medicina críticaTwitterG+
Trauma ProfessionalTwitter
Rollcage MedicTwitter
Dr ERMedia
ECG interpretation
Broad Complex
EMCrit BlogTwitterFBG+PodcastMedia
Annals of Emergency MedicineTwitterFBPodcast
ACEP nowTwitter
EM GuidelinesTwitterG+
Cosas del PAC
Urgencias Bidasoa
Eastern AssociationTwitterFBPodcast
EMS 12 leadTwitterFBPodcast
EP MonthlyTwitterFB
Resus METwitterFBPodcast
Dr Smith's ECG BlogTwitterFB
CDEM Twitter
Edwin LeapTwitter
Anesthesia - ICUG+
Rogue Medic
Emergency Medic
ER Nurses Blog
Medgadget: EM ArchivesTwitterFB
Pediatric EducationTwitterFB
Medical News TodayTwitterFBG+
5 Minute AirwayTwitter
EM BytesTwitterFB
LAEM DoctorsTwitter
Ditch DocTwitterFB
ICU Education
Paciente CriticoTwitterFB
Bits and BumpsTwitter
ICM Case StudiesTwitter
EDtime StoriesTwitterFB
PEM GeekTwitter
Sketchy EBMTwitterFBMedia
Ecografia en UCITwitterMedia
Essential Critical CareTwitter
Ultrasound of the weekTwitter
wAIN's WorldTwitterFB
Survive ED
Adelaide EMTwitter
Shak EMTwitter
Vinnies ICU
All NYC EMTwitterG+
EM CuriousTwitterFB
Medics MedicineTwitter
Flipped EMTwitterFBG+
UK ED MonkeyTwitter
HEFT EMTwitterPodcast
The Poison ReviewTwitterFB
DGINA BlogTwitterFB
Chile Emergency MedicineTwitterFBG+Media
FOAM FeedsTwitterG+
Injectable OrangeTwitter
Paediatric EMTwitterG+
PICU DoctorTwitterFB
RAGE podcastTwitter
Improving Care in EDTwitter
VENN of EMTwitter
EM etcTwitterG+
Resus Room MxTwitter
Rural DocsTwitter
Twitter Mass CasualtyTwitter
EM DutchTwitter
EM REMSTwitter
Essentials of EMTwitterFBG+
servicio deurgencia pacTwitter
The EM Res PodcastTwitterFBG+PodcastMedia
EM 20 WikiTwitterG+Media
EM IM DocTwitter
Paterson ERTwitter
PEM LiteratureTwitter
The Blunt DissectionTwitter
Emergency Ultrasound TeachingTwitter
Resus ReviewTwitterG+Media
EM BasicTwitterFBPodcast
Emergency WebNotes
Everyday MedicineTwitterFBPodcast
Emergency Room NurseTwitter
The Sharp EndTwitterFBMedia
EM LyceumTwitterFB
PEM EDTwitterFBPodcast
Dr Cottles DeskG+
Critical Care in the ED
Practical EvidenceTwitterPodcast
Sonography 123TwitterFBMedia
Stories from a Kiwi ParamedicFB
Global Emergency MedicineTwitter
Adventures in Emergency MedicineTwitter
Academic Emergency Medicine
Asystole: The Most Stable RhythmTwitter
The Central LineTwitter
ED informatics
Ivor KovicTwitter
Receiving The place for EM
Movin' MeatTwitter
Tales form the ER
EM Physician Backstage Pass
Mr Hassles Long Underpants

Emergency Medicine trainee. Interests in ophthalmology, critical care and clinical research.

BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |


  1. Fascinating review of the changing landscape… as a new #FOAMed creator I can see how frustrating it is to try to make noise in a space that is crowded by so many established websites and personalities with such huge followings. It’s a HUGE time commitment to be consistent to grow a following.

    That is an impressive bandwidth bill!

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